Severe menstrual cramps — could it be endometriosis?

Endometriosis can be diagnosed in several ways. A pelvic exam can reveal the presence of tender, thickened areas outside the uterus, while ultrasound may detect tissue patterns on the ovaries, suggestive of endometriosis.

by Sima Aidun — 

Endometrium is the tissue that lines the uterus and is shed during the menstrual period. In some women, the same tissue can be found growing where it doesn’t belong, outside the uterus. For example, it can grow on the ovaries, bowel or bladder and, though rare, can be found in locations far from the pelvis, like old abdominal scars or even the lungs. Such abnormal growth of the endometrium is called endometriosis.

Presently, the most probable explanation for endometriosis is the passage of menstrual blood out of the uterus (backward) into the abdomen, or the spread of the uterine lining cells through the blood stream or lymph system to other parts of the body. Several proposed studies may research multiple causes of endometriosis, and evidence suggests that any or all of these theories may be possible.

Genetics also appear to play a role, as women with a mother or sister with endometriosis have a much higher risk of developing the disease. It is likely that an inherited immune system defect plays some role in allowing the development of this condition. Additionally, some researchers have found a link between the development of endometriosis and environmental toxins.

The appearance of endometriosis changes over time. Each area of endometriosis, called an implant, is generally about a square inch in size, but may be slightly smaller or larger. It is believed that new endometriosis tissue starts small and, over time, grows and collects pigment. As this occurs, the implants, located in different areas outside the uterus, become pink, then dark red and finally brown.

Endometriosis can be diagnosed in several ways. A pelvic exam can reveal the presence of tender, thickened areas outside the uterus, while ultrasound may detect tissue patterns on the ovaries, suggestive of endometriosis.

The diagnosis of endometriosis can only be confirmed by examining the pelvic organs through a surgical procedure called laparoscopy, which is most commonly done under general anesthesia. A small, lighted instrument is inserted through the navel, allowing the surgeon to look through the instrument directly; or a view of the pelvis can be projected onto a video screen with the aid of a camera attached to the laparoscope.

At times, the diagnosis is made following a laparotomy, after which abdominal surgery is performed under either general or regional (such as epidural) anesthesia.

Treatment is divided into three paths: observation, medication or surgery. Observation can determine whether any treatment is required, since women with minimal or mild endometriosis who do not have pain may require only careful follow-ups. The prescribed medications include progesterone, birth control pills, GnRH agonist and Danocrine. As a final resort, surgery may be called for.

Traditional medicine aims to treat endometriosis by reducing the symptoms, which include premenstrual pain, severe menstrual cramps, chronic pain in the pelvic area, pain during or after sex, premenstrual low back pain, painful bowel movement or fertility problems.

Using naturopathic modalities like herbal medicines, nutritional supplements (especially specific formulated systemic enzymes) and dietary modifications, endometriosis has become one of many female conditions to be treated with great success. If fertility is a goal, acupuncture is another great addition to the above-mentioned modalities.

Dr. Sima Aidun is a naturopathic medical doctor and founder of Natural Solutions for Women in Scottsdale, Ariz., focusing primarily on women’s health. 480-314-7600.

Reprinted from AzNetNews, Volume 25, Number 1, February/March 2006.